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Preserve the Brain: Primary Goal in the Therapy of Atrial Fibrillation∗
Treatment of atrial fibrillation (AF) involves 3 major strategies: prevention of stroke, maintenance of sinus rhythm, and rate control . Stroke is the most dreaded complication of AF, and its prevention is key. Anticoagulation with warfarin and the newer agents dabigatran, rivaroxaban, and apixaban is highly effective in preventing strokes in patients with AF . However, defining the appropriate patient for anticoagulant therapy is not an exact science, and the stroke risk schema CHADS2 (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, previous Stroke/transient ischemic attack) and CHA2DS2-VASc (...
Source: Journal of the American College of Cardiology - May 17, 2013 Category: Cardiology Authors: Eric N. Prystowsky, Benzy J. Padanilam Tags: Heart Rhythm Disorders: Editorial Comment Source Type: research

Can I use DOAC in a patient with renal disease?
Case A 76-year-old man is diagnosed with non-valvular atrial fibrillation. His comorbid conditions are hypertension, diabetes complicated by neuropathy, and chronic kidney disease stage 3. His current medications include metformin, lisinopril, gabapentin, and aspirin. His most recent laboratories showed a creatinine 1.8, creatinine clearance (CrCl) 35 mL/min, hemoglobin 11g/dL, and international normalized ratio 1.0. His congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, and sex (CHADSVASc) score is 4. Which medication should we use to prevent stroke in this patient?  Brief overview of the is...
Source: The Hospitalist - February 3, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: Renal & Genitourinary Source Type: research

An Aspirin a Day: Is the Benefit Worth the Risk?
Studies have shown that aspirin, the age old remedy for pain and fever, also thins the blood. Because of this property, it can also help to lower the chances of a heart attack or a stroke caused by a blood clot in the brain. And, although research has found that it only works in certain people (specifically, those with a history of heart attack or stroke) many Americans are inappropriately taking daily, low doses of aspirin as a preventative measure. In fact, researchers have found that about 12 percent of the of nearly 69,000 U.S. adults taking aspirin on a long-term basis should not have received the prescription in the ...
Source: Healthy Living - The Huffington Post - March 13, 2015 Category: Consumer Health News Source Type: news

Trends in antithrombotic therapy for atrial fibrillation: Data from the Veterans Health Administration Health System
Conclusions Among US veterans with new AF and additional risk factors for stroke, only about half receive OAC, and the proportion is declining.
Source: American Heart Journal - September 3, 2016 Category: Cardiology Source Type: research

Dabigatran and vitamin K antagonists ’ use in naïve patients with non-valvular atrial fibrillation: a cross-sectional study of primary care-based electronic health records
ConclusionsMost patients recently diagnosed with non-valvular atrial fibrillation initiated treatment with VKA. Primary healthcare patients with non-valvular atrial fibrillation initiating dabigatran are younger, had a lower risk of stroke or bleeding, fewer comorbidity and more history of stroke and intracranial haemorrhage compared to those who were initiated on VKA.
Source: European Journal of Clinical Pharmacology - July 19, 2017 Category: Drugs & Pharmacology Source Type: research

Nonvitamin K Antagonist Oral Anticoagulants Use in Patients with Atrial Fibrillation and Bioprosthetic Heart Valves/Prior Surgical Valve Repair: A Multicenter Clinical Practice Experience
Semin Thromb Hemost DOI: 10.1055/s-0037-1615261This is an observational study to investigate the efficacy and safety of nonvitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with bioprosthetic valves or prior surgical valve repair in clinical practice. A total of 122 patients (mean age: 74.1 ± 13.2; 54 females) with bioprosthetic heart valve or surgical valve repair and AF treated with NOACs were included in the analysis. The mean CHA2DS2-VASc (Congestive heart failure, Hypertension, Age >75 years, Diabetes mellitus, prior Stroke or transient ischemic attack, Vascular disease) and...
Source: Seminars in Thrombosis and Hemostasis - January 5, 2018 Category: Hematology Authors: Russo, Vincenzo Attena, Emilio Mazzone, Carmine Esposito, Francesca Parisi, Valentina Bancone, Ciro Rago, Anna Nigro, Gerardo Sangiuolo, Raffaele D' Onofrio, Antonio Tags: Original Article Source Type: research

Label Adherence for Non-Vitamin K Antagonist Oral Anticoagulants in a Prospective Cohort of Asian Patients with Atrial Fibrillation.
CONCLUSION: In real-world practice, more than one-third of patients with NOAC prescriptions received an off-label reduced dose, which could result in an increased risk of stroke. Considering the high risk of stroke in these patients, on-label use of NOAC is recommended. PMID: 30799590 [PubMed - in process]
Source: Yonsei Medical Journal - February 28, 2019 Category: Universities & Medical Training Authors: Lee SR, Lee YS, Park JS, Cha MJ, Kim TH, Park J, Park JK, Lee JM, Kang KW, Shim J, Uhm JS, Kim J, Kim C, Kim JB, Park HW, Joung B, Choi EK Tags: Yonsei Med J Source Type: research

Early Adoption of Dabigatran and Its Dosing in US Patients With Atrial Fibrillation: Results From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation Health Services and Outcomes Research
Conclusions Patients receiving dabigatran were younger and at a lower risk of stroke and bleeding. Patients appeared to drive switching from warfarin, whereas clinical characteristics influenced de novo start of dabigatran. These data suggest cautious early uptake of dabigatran, and more careful attention to dosing adjustments is warranted. Clinical Trial Registration URL: Clinicaltrials.gov. Unique identifier: NCT01165710.
Source: JAHA:Journal of the American Heart Association - November 25, 2013 Category: Cardiology Authors: Steinberg, B. A., Holmes, D. N., Piccini, J. P., Ansell, J., Chang, P., Fonarow, G. C., Gersh, B., Mahaffey, K. W., Kowey, P. R., Ezekowitz, M. D., Singer, D. E., Thomas, L., Peterson, E. D., Hylek, E. M., The Outcomes Registry for Better Informed Treatme Tags: Health Services and Outcomes Research Source Type: research

Vitamin K and non-vitamin K antagonists oral anticoagulants for non-valvular atrial fibrillation in real-life.
CONCLUSION: Patients given rivaroxaban and apixaban in clinical practice have a higher thrombotic and hemorrhagic risk in comparison with patients given dabigatran or VKAs. A considerable proportion of patients receive reduced doses of NOACs. PMID: 27394924 [PubMed - as supplied by publisher]
Source: European Journal of Internal Medicine - July 5, 2016 Category: Internal Medicine Authors: Giustozzi M, Vedovati MC, Verdecchia P, Pierpaoli L, Verso M, Conti S, Cianella F, Marchesini E, Filippucci E, Agnelli G, Becattini C Tags: Eur J Intern Med Source Type: research

Improved persistence with non-vitamin K oral anticoagulants compared with warfarin in patients with atrial fibrillation: recent Australian experience.
CONCLUSIONS: Persistence with NOAC drugs in patients with AF appears to be superior to warfarin. If continued long-term, this alone will be of clinical importance in the prevention of stroke and death. PMID: 27463735 [PubMed - as supplied by publisher]
Source: Current Medical Research and Opinion - July 29, 2016 Category: Research Tags: Curr Med Res Opin Source Type: research

Important factors affecting the choice of an oral anticoagulant may be missed in database studies
This article is protected by copyright. All rights reserved.
Source: Journal of Internal Medicine - September 7, 2017 Category: Internal Medicine Authors: Emma Aarnio, Risto Huupponen, Maarit Jaana Korhonen Tags: Letter to the Editor Source Type: research

Novel oral anticoagulants in chronic kidney disease: ready for prime time?
Purpose of review Patients with chronic kidney disease (CKD) are at increased risk of atrial fibrillation, stroke, and bleeding posing unique clinical challenges. Novel oral anticoagulants (NOACs) including dabigatran, rivaroxaban, and apixaban have become recognized as alternative therapy to Vitamin K Antagonists (VKA) regarding the prevention of venous thromboembolism (VTE) and reduce the risk of stroke in atrial fibrillation. However, the understanding of NOACs in CKD is still underdeveloped. This review summarizes recent literature on the efficacy and safety of NOACs in patients with CKD. Recent findings Studies f...
Source: Current Opinion in Nephrology and Hypertension - April 5, 2018 Category: Urology & Nephrology Tags: EPIDEMIOLOGY AND PREVENTION: Edited by Navdeep Tangri Source Type: research

Preventable Cases of Oral Anticoagulant-Induced Bleeding: Data From the Spontaneous Reporting System
Conclusion: Our findings describe the most reported risk factors for preventability of oral anticoagulant-induced bleedings. These factors may be useful for targeting interventions to improve pharmacovigilance activities in our regional territory and to reduce the burden of medication errors and inappropriate prescription. Introduction Oral anticoagulant therapy is widely used for the prevention of stroke and systemic embolism in patients with atrial fibrillation, or for the prevention and treatment of deep vein thrombosis and pulmonary embolism (Raj et al., 1994; Monaco et al., 2017). Oral anticoagulants can be di...
Source: Frontiers in Pharmacology - April 29, 2019 Category: Drugs & Pharmacology Source Type: research

Right drug, wrong dosage: insights from the PAVE-AF antithrombotic study in older patients with atrial fibrillation
AbstractOptimal antithrombotic treatment of older patients is usually impeded by several prevailing misconceptions. The aim of our study was to assess the type, dosage and predictors of antithrombotic therapy in older patients with non-valvular atrial fibrillation (NVAF). PAVE-AF was a prospective, cross-sectional study, including NVAF patients ≥ 80 years from 30 participating centers. Demographic data, comorbidities and treatment patterns were documented in a single visit. Patients treated with non-vitamin K oral anticoagulants (NOACs) were further classified into three dosing categories (recommended, underdosing and o...
Source: Journal of Thrombosis and Thrombolysis - June 8, 2020 Category: Hematology Source Type: research

The Risk of Falling and Consequences of Falling in Patients with Atrial Fibrillation Receiving Different Types of Anticoagulant
ConclusionOlder patients who had comorbidities and were taking amiodarone, diuretics, or short- or medium-acting benzodiazepines had the highest risk of falls. The type and quality of anticoagulation did not seem to affect the risk of falling but did significantly affect survival after the first fall.
Source: Drugs and Aging - March 2, 2021 Category: Geriatrics Source Type: research

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